Treatment of Infected Ear Piercing
For infected ear piercings, treatment depends critically on whether the infection involves the earlobe (superficial) or cartilage (perichondritis), with cartilage infections requiring immediate fluoroquinolone antibiotics to prevent permanent deformity. 1
Initial Assessment: Distinguish Superficial from Deep Infection
The most critical first step is determining infection depth, as this dictates treatment and prognosis:
- Check for cartilage involvement by deflecting the auricular cartilage—acute tenderness indicates perichondritis requiring systemic antibiotics 2, 1
- Superficial earlobe infections present with localized redness, warmth, and drainage around the piercing site 2
- Perichondritis presents with painful swelling, warmth, and redness that often spares the earlobe, typically occurring within the first month after piercing 2, 1
- Most infections occur during warm-weather months and within the first month post-piercing 2, 1
Treatment Algorithm
For Minor Earlobe Infections (Superficial)
- Remove the earring immediately to prevent embedding and allow drainage 1
- Apply topical antibiotic (such as bacitracin 1-3 times daily) for very mild infections 1, 3
- Monitor for 48 hours—failure to improve requires escalation to systemic antibiotics 1
For Cartilage Infections (Perichondritis)
Start fluoroquinolone antibiotics immediately (ciprofloxacin or levofloxacin) due to their effectiveness against the most common pathogens: Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pyogenes 2, 1, 4
- Fluoroquinolones are essential because Pseudomonas aeruginosa is a predominant pathogen in cartilage infections and other antibiotics often fail 5, 6, 4
- Alternative antibiotics for hospitalized patients include clindamycin, ceftazidime, or cefepime depending on culture results 2
- Duration of therapy: typically 6 days intravenous followed by 15 days oral (median 16 days total) 4
For Abscess Formation
- Surgical incision and drainage are necessary when an abscess develops 2, 1
- Warning: Once an abscess forms, good cosmetic preservation of auricular cartilage becomes extremely difficult to maintain 2
For Allergic Reactions (Contact Dermatitis)
- Remove the earring and avoid the offending metal (commonly nickel) 2, 1
- Apply topical corticosteroids to hasten resolution 2, 1
- Use hypoallergenic metals (surgical steel, titanium, or gold) for future piercings 1
Critical Pitfalls to Avoid
- Never treat cartilage infections without Pseudomonas coverage—this leads to treatment failure and permanent cosmetic deformity 1, 5, 6
- Do not delay earring removal in the presence of infection, as this promotes embedding and abscess formation 1
- Do not miss perichondritis—failure to recognize deeper infection results in cartilage necrosis 1, 5
- Avoid using piercing guns on cartilage, as they cause tissue damage that increases infection risk 5
Warning Signs Requiring Urgent Care
- Spreading infection or systemic symptoms (fever, malaise) 1
- Formation of an abscess 1
- Failure to improve after 48 hours of appropriate antibiotic therapy 1
- Development of severe complications such as infective endocarditis (rare but reported with MRSA) 7
Post-Treatment Management
- Wait 6-8 weeks after complete resolution of swelling and tenderness before repiercing 2, 1
- Repierce in an unscarred area if the original site has closed 2
- Consider earrings with locking or screw backs to prevent future embedding, especially in children 2, 1